(Poster 140) Burch Colposuspension vs Midurethral Sling at the Time of Robotic Sacrocolpopexy

Objectives: Concomitant surgical treatment for stress urinary incontinence (SUI) is commonly performed for women undergoing sacrocolpopexy (SCP) for apical prolapse. Both the Burch colposuspension and midurethral sling (MUS) are well-studied, effective surgical options for the treatment of SUI. Prior studies have shown similar long-term success and patient satisfaction between the Burch colposuspension and MUS. With growing use of the robotic approach for sacrocolpopexy, our objective was to compare patient outcomes at 1 year between robotic Burch and MUS for SUI at the time of robotic sacrocolpopexy.

Methods: This is a retrospective chart review of women with SUI who underwent Burch colposuspension or MUS with concomitant robotic sacrocolpopexy at our institution from January 2005 to May 2021. Adhering to strict exclusion criteria, 83 patients were included in the study, with 25 patients in the MUS group (MUS + SCP) and 58 in the Burch group (Burch + SCP). Patient characteristics, preoperative data, operative data, and postoperative outcomes were collected. Group differences were assessed using Fisher’s exact tests or Wilcoxon rank-sum tests.

Results: BMI and postmenopausal status were different between the two groups, with more postmenopausal women in the Burch colposuspension group (52.0% vs 81.0%, p=0.01) and higher BMIs in the MUS group (27.5 vs 25.2, p=0.01). Other patient characteristics such as age, medical comorbidities, tobacco use, parity and prior hysterectomy status did not differ between the two groups. Patients who underwent concomitant MUS were more likely to have a preoperative diagnosis of MUI (48.0% vs 8.6%, p< 0.001), posterior-dominant prolapse (36.0% vs 12.0%, p=0.02), and higher intraoperative EBLs (100cc vs 50cc, p< 0.001). There were no differences in the subjective (84.0% vs 80.4%, p=0.77) or objective (100.0% vs 95.0%, p=0.99) absence of SUI at 1 year or hospital length of stay (33 vs 34 hours, p=0.92) for MUS or Burch patients, respectively. Similarly, there were no differences in operative time (375 vs 336 minutes, p= 0.32), major postoperative complications at 6 weeks (44.0% vs 32.8%, p=0.33) or 1 year (32.0% vs 15.5%, p=0.14).

Conclusions: The Burch colposuspension and midurethral sling are both effective options for the treatment of SUI at the time of prolapse repair via robotic sacrocolpopexy.

Table 1. Preoperative Characteristics: Baseline characteristics including medical comorbidities, types of incontinence, urodynamics and compartments of prolapse were collected. A P value of < 0.05 was considered significant. *Results are reported as count (column percentage) or median [first and third quartiles]. Missing data indicated where denominator counts are reported.

Table 2. Postoperative Outcomes: Subjective and objective postoperative data were collected. Results are reported as count (column percentage) or median [first and third quartiles]. Missing data indicated where denominator counts are reported.